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    Client Feedback Form

    Uploaded by

    ASHLEE DADOR FERRER
    The document is a consent form and feedback form for HAFA Clinical Laboratory. It asks clients to complete a questionnaire to provide feedback on the laboratory's services to help improve quality. It states that answers are confidential and participation is voluntary. The feedback form then asks questions regarding accessibility, provision of information, technical and administrative services to gauge client satisfaction.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Client Feedback Form

    Uploaded by

    ASHLEE DADOR FERRER
    1K views4 pages
    The document is a consent form and feedback form for HAFA Clinical Laboratory. It asks clients to complete a questionnaire to provide feedback on the laboratory's services to help improve quality. It states that answers are confidential and participation is voluntary. The feedback form then asks questions regarding accessibility, provision of information, technical and administrative services to gauge client satisfaction.

    Original Title

    CLIENT FEEDBACK FORM

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    The document is a consent form and feedback form for HAFA Clinical Laboratory. It asks clients to complete a questionnaire to provide feedback on the laboratory's services to help improve quality. It states that answers are confidential and participation is voluntary. The feedback form then asks questions regarding accessibility, provision of information, technical and administrative services to gauge client satisfaction.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views4 pages

    Client Feedback Form

    Uploaded by

    ASHLEE DADOR FERRER
    The document is a consent form and feedback form for HAFA Clinical Laboratory. It asks clients to complete a questionnaire to provide feedback on the laboratory's services to help improve quality. It states that answers are confidential and participation is voluntary. The feedback form then asks questions regarding accessibility, provision of information, technical and administrative services to gauge client satisfaction.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    CONSENT FORM

    Dear Clients,

    Your satisfaction regarding the services provided by HAFA Clinical Laboratory is an


    important indicator for the quality of our work. We therefore would like to ask you to
    complete this questionnaire and help us improve our services.

    Please know that this questionnaire is not meant to test you, but to get an indication of the
    performance of the laboratory from your perspective. Your answers will be used to optimize
    our services.

    You will be asked about several aspects of the services provided to you by the HAFA Clinical
    Laboratory. Your answers are only used by the laboratory to improve its services and will not
    be given to others. Your answers will be treated confidentially and you will remain
    anonymous . Your participation is voluntary and you can stop your participation at any time
    and withdraw your permission to use the information given by you.

    I have read this form and agree with the contents:

    Date

    HAFA Clinical Laboratory, Roxas Avenue, Brgy. Pequeña, Naga City, Philippines
    [email protected] Tel No: 655-4712
    HAFA CLINICAL LABORATORY
    Roxas Avenue, Brgy. Pequeña, Naga City Philippines
    [email protected] Tel no: 655-4712

    FEEDBACK FORM

    Name: (Optional) Age: Sex:

    Address: Date of visit:

    Phone no: (Optional) Email: (Optional)

    Tell us how we are doing with our Patient Questionnaire


    SECTION A: LABORATORY ACCESSIBILITY

    Please tick the box which most closely describes your views.

    1. Do you always get contact with the laboratory staff when needed? YES NO

    2. Are you satisfied with the communication between you and the YES NO
    laboratory staff?
    IF NO, PLEASE SPECIFY:

    3. Does the laboratory staff always help you solve your problems?
    YES NO

    4. How do you usually communicate with the laboratory?

    EMAIL TELEPHONE FACE TO FACE MEETING OTHERS:

    SECTION B: PROVISION OF INFORMATION

    1. Has the laboratory provided you with the information on which YES NO
    tests are available at the laboratory?

    2. Has the laboratory provided you with the information on the YES NO
    clinical use of each test?

    3. Has the laboratory provided you with the instructions for sample YES NO
    collection?

    4. Has the laboratory provided you with the information on how the
    YES NO
    result will be reported?

    5. Is the request form clear? YES NO


    HAFA CLINICAL LABORATORY
    Roxas Avenue, Brgy. Pequeña, Naga City Philippines
    [email protected] Tel no: 655-4712

    SECTION C: PROVISION OF SERVICES

    How satisfied are you with each of the following technical services?




    Very
    Very
    Satisfied Neutral Unsatisfied Unsatisfied
    Satisfied

    Quality/reliability of
    test results.

    Turn-around times
    for routine tests.

    Variety of type of
    tests offered.

    Response to
    technical questions
    and concerns.

    Quality of phone
    and email
    communications
    with lab staff.

    Clarity/usefulness
    of the lab report
    and/or supporting
    documentation you
    received.

    Scope of services
    offered.

    Cost of tests.

    HAFA CLINICAL LABORATORY


    Roxas Avenue, Brgy. Pequeña, Naga City Philippines
    [email protected] Tel no: 655-4712

    Please rate your experience for the following Administrative or Support Services.

    Very Very
    Satisfied Neutral Unsatisfied
    Satisfied Unsatisfied
    Lab staff were
    knowledgeable, helpful,
    courteous and
    professional.

    Response was
    prompt.

    Received requested
    information or test
    containers in a timely
    manner.
    Information received
    was clear and useful.

    Business hours are


    convenient.

    Please rate your overall experience with the services you have received from HAFA
    Clinical Laboratory.

    Exceeded Met Did Not Meet Don't Know


    expectations expectations expectations

    What can we do to better serve you? Please add any additional comments or suggestions relative
    to your satisfaction with HAFA Clinical Laboratory, your experiences with the lab support or
    business staff, improving our services, or a general comment.

    We appreciate your feedback. Thank you.

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